第四節(jié)　小兒脾臟的外科應(yīng)用解剖

脾位于左季肋部,第9 和第11 肋間。 整個(gè)脾臟被腹膜包繞,由脾胃韌帶、脾腎韌帶和脾結(jié)腸韌帶固定。 脾質(zhì)軟脆,色澤暗紅、略呈橢圓形,可分為膈、臟兩面,前后兩緣和上、下兩端。 臟面凹陷,近中央處為脾門,是神經(jīng)、血管出入之處。 前緣較銳,下部有2～3 個(gè)切跡,稱為脾切跡。

脾臟由腹腔動(dòng)脈的最大分支脾動(dòng)脈供血,該動(dòng)脈自右向左走行于胰腺上緣,沿途分出若干小支入胰腺,然后經(jīng)脾腎韌帶間,接近脾門時(shí)分出胃短動(dòng)脈和胃網(wǎng)膜左動(dòng)脈。 在脾門分2～3 支主干進(jìn)入脾臟,分為脾上葉、脾下葉2 支主干進(jìn)入脾臟者,約占84%;余16%分為脾上、中、下葉三主干。 這些血管與脾臟長(zhǎng)軸平行,每支葉動(dòng)脈又分出與之垂直的 5～6 支小梁動(dòng)脈,至脾外周成為終末小動(dòng)脈。 脾靜脈起于脾外周血竇,與動(dòng)脈相伴,在動(dòng)脈之后出脾,行經(jīng)胰腺背面,到胰頸部與腸系膜上靜脈匯合為門靜脈。

脾臟的淋巴引流到脾門淋巴結(jié)。 15%～40%的人有副脾,數(shù)目不定。 多者5～6 個(gè),常在脾門附近,也可在胰尾、脾韌帶、網(wǎng)膜、小腸系膜,甚至在左側(cè)卵巢或左側(cè)睪丸內(nèi)。

脾的表面有菲薄的纖維性被膜與腹膜相連,被膜的纖維組織深入脾內(nèi),形成一系列的小梁,是脾的支架。 小梁之間有脾髓。 脾實(shí)質(zhì)分白髓和紅髓兩部分。 白髓即淋巴細(xì)胞圍繞小動(dòng)脈部分,由大量T 細(xì)胞和B 細(xì)胞組成。 紅髓以網(wǎng)狀內(nèi)皮細(xì)胞為主,排列成細(xì)胞帶,形成豐富的血竇。

小兒由于年齡不同,脾臟重量差異極大,各年齡兒童脾臟重量在10～113g 之間。 脾臟是最大的網(wǎng)狀內(nèi)皮細(xì)胞器官和淋巴器官。 脾包膜的纖維深入脾內(nèi),形成一系列小梁,小梁之間為脾髓。 脾實(shí)質(zhì)分白髓和紅髓兩部分。 白髓即淋巴細(xì)胞圍繞中央小動(dòng)脈周圍部分,多為T 淋巴細(xì)胞,為胸腺依賴區(qū)。 紅髓在白髓周圍,分為髓索及髓竇,是胸腺非依賴區(qū),即B 淋巴細(xì)胞所在地之一。

(盧　云)

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